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This is VAERS ID 274790

Case Details

VAERS ID: 274790 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Virginia  
Vaccinated:2007-03-06
Onset:2007-03-09
   Days after vaccination:3
Submitted: 2007-03-20
   Days after onset:10
Entered: 2007-03-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2307AA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 00886 / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2638AA / 1 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall
Current Illness: NONE/Well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: R arm redness, pain, swelling. Shortly after.


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